The sex talk is enough to send just about any parent into a tailspin of anxiety. Such anxiety can affect the quality of the conversation, your child’s attitudes about sex, and your child’s willingness to come to you with future sex-related questions. If your kid thinks he or she is going to be met with an anxious, flustered parent who conveys negativity, the child is much more likely to consult a friend—which can lead to misinformation.

Before you talk with your child about sex, you’ll need to examine your own attitudes so that you can convey comfort and confidence. While there’s no guarantee that you can completely move past your anxiety, there are a few things you can do to minimize it.

Examine Your Own Attitudes
Before you begin trying to shape your child’s attitudes about sex, look at your own ideas. Many parents, for example, want children to have healthy attitudes toward sex but feel uncomfortable with the topic themselves. Children believe what their parents do, not what they say, and no matter how positively you speak, negativity will rub off on your child.

Spend some time thinking about particular topics that make you uncomfortable and examine why these might be hot-button issues for you. If you have sexual issues of your own, it’s a good idea to talk to a therapist before you talk to your child. If there’s a specific topic that makes you uncomfortable, try delegating that topic to your spouse or a trusted family friend.

Start Early
There’s no way you can convey all the information your child needs to know about sex in a single talk, and trying to do so can spell disaster. Parents should start talking to their children about sex early, and continue providing age-appropriate information as children develop.

Starting early can help you move past your own anxiety. After all, it’s usually easier to talk to an adoring 6-year-old than to a judgmental teenager. By starting early, you get into the habit of talking about sex with your child, and this can make it easier to talk about other challenging subjects as your child gets older.

Make It Natural
Anything can start a conversation—a television show, news story, or the experience of a family member. There’s no need to corner your child and start a highly serious talk. Instead, use every opportunity you can to talk about sex in a comfortable, low-key environment.

When you let the conversation flow naturally, you’re less likely to build up dread. Conversations that occur as part of everyday events tend to be shorter, too, which can help reduce anxiety and stress.

Lower the Stakes
Sex conversations can seem like high-stakes talks, during which you must give every conceivable piece of information your child might ever need. This attitude can contribute to parental anxiety and make your child not want to talk to you about sex again.

Instead, try treating sex like any other topic, raising it in an easy, low-key manner. Pretend you’re talking about how to safely cross the road or how to kick a soccer ball. Heavy-handed approaches may be more likely to be met with skeptical, dismissive, or even rebellious reactions.

Ask for Feedback
Most parents’ conversations with their children are two-sided. You might each share what you did during the day or discuss your thoughts on a family member or political issue. But parents tend to make the sex talk one-sided, lecturing their children and expecting them to take in a huge quantity of information.

This practice not only makes it less likely that your child will get good information, it can also increase your anxiety. Instead, try asking your child his or her thoughts, asking how much he or she has learned, or even asking if the child feels like he or she can trust the information you’re giving. This gives your kid a chance to provide feedback and ask questions, and makes the sex talk seem much more like any other conversation.

References:

1. Park, A. (2009, December 07). Parents’ sex talk with kids: Too little, too late. Time Magazine. Retrieved from http://www.time.com/time/health/article/0,8599,1945759,00.html
2. Talking with kids about sex and relationships. (n.d.). Talk With Your Kids. Retrieved from http://www.talkwithkids.org/sex.html

Insecurity is one of the trickiest relationship issues because it tends to create a self-perpetuating cycle. Insecure people frequently cling to their partners, which causes their partners to pull away, worsening the insecurity.

Feelings of insecurity often begin with family-of-origin issues or unhealthy early relationships. In many people, these experiences may interfere with their ability to choose good partners; some insecure people may choose partners who make the insecurity worse. There’s no quick fix for anxiety, and some people need therapy to move past anxiety in relationships, but there are several steps you can take to reduce it:

Determine the Cause

Not all insecurity is unwarranted. Objectively examine the behavior of your partner. Is he or she honest? Does he or she respond to your basic needs? Does he or she seem concerned about your feelings?
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If you’re not getting what you need in your relationship, your insecurity might be the other person’s problem, not yours. But this doesn’t mean you can force your partner to fix it. If your partner refuses to meet reasonable emotional needs, you can either end the relationship or find other ways to meet your needs, perhaps by taking up a hobby, expanding your circle of friends, or finding fulfillment in your work.

Negotiate Relationship Rules

Every relationship serves as a sort of mini-government that establishes its own rules and standards of behavior. Something that’s OK in your relationship might not be OK in another person’s relationship.
Talk to your partner about how you want your relationship to function and how each of you can get your needs met. You might, for example, agree that you need a lot of verbal reassurance, while your partner benefits more from favors and nice gestures.

When insecurity is a chronic problem, you should talk openly and honestly about it so that your partner knows you might need extra reassurance. If you have a disagreement about what constitutes a fundamental need, you might need to get out of the relationship or find another way to meet your needs.

Avoid Mind Reading

No two people think exactly alike, and what might mean absolute rejection to you could just be an oversight or misstatement by your partner.
Mind reading can contribute to insecurity when you make assumptions about your partner’s thoughts rather than asking him or her about them. If you’re feeling unsure of something, express this to your partner and ask for clarification.

Quit the Comparison Game

Almost any relationship, no matter how troubled, can look perfect from the outside looking in. Don’t compare your relationship to other people’s relationships, and avoid comparing your current partner to past partners.
It’s easy to find your partner’s weaknesses and assume that he or she doesn’t love you, and when you compare relationships, you’re much less likely to compare your partner’s positive traits to other people’s negative traits. Accept your partner for who he or she is and work on your relationship where it is rather than aspiring to emulate a relationship that might not even be real.

Look for the Positive

Confirmation bias is a psychological phenomenon that causes people to look for evidence of what they already believe to be true. If you’re convinced that your partner doesn’t love you, you might see his or her failure to say he/she loves you on the phone as irrefutable evidence that love has died.
But when you look for confirmation of the positive aspects of your relationship, you’re also more likely to find these. Focus on your partner’s positive traits, and interpret ambiguous statements and actions as positively as possible. In minor cases of insecurity, this can be all it takes to move past anxiety.

References:

1. 20 ways to beat relationship insecurity. (n.d.). YourTango. Retrieved from http://www.yourtango.com/200948412/how-beat-relationship-insecurity
2. Cassidy, J., & Shaver, P. R. (1999). Handbook of attachment: Theory, research, and clinical applications. New York, NY: Guilford Press.

Hypnosis has long been fodder for television shows and stand-up acts, and most people are familiar with hypnotists who claim to be able to make anyone do anything while under hypnosis. But hypnosis is no longer just a sideshow performance, and an increasing number of people are turning to hypnosis to quit smoking, get over depression and anxiety, lose weight, and forget about phobias.

Hypnosis is still controversial within mental health, partially because it’s often part of a comedy act and not real treatment and partially because some hypnotherapists have induced false memories under regression-based hypnotherapy.

What Is It?
Hypnosis isn’t a magic trick. It’s an altered state of consciousness that hypnotists induce via the power of suggestion. Hypnotists may use relaxation techniques, key words, guided imagery, or some combination of these to help clients slowly relax. Then, while under hypnosis, hypnotists make suggestions about changes in behavior.

The idea behind hypnosis is that, even when the conscious mind wants to do something, the unconscious mind might not fully accept this change. Hypnotists claim that, under the right conditions, they can subtly alter the effects the unconscious mind has on the conscious mind and help bring about behavioral changes. Some hypnotists use hypnosis to help gradually alter a client’s perceptions. A person struggling with pain, for example, might undergo hypnosis to help him or her see the pain as pressure. An increasing number of women are even using hypnosis to help cope with the pain of childbirth.

Does It Work?
You can’t be hypnotized to do something that is outside of your moral compass or that you don’t really want to do. People who try to quit gambling or spending through hypnosis will likely not see results if they’re quitting only because of family pressure. Hypnosis can’t change the way you think; it simply makes it easier to follow through with behavioral changes. Hypnosis can also bring about a state of relaxation, and some hypnotherapists teach their clients how to self-hypnotize under stressful conditions. For people with anxiety issues, severe stress, or depression, this can help ease the symptoms.

But hypnosis is not a panacea, and is most effective when it’s used in conjunction with therapy and lifestyle changes. Particularly for long-term, chronic problems, it may take several hypnosis sessions to see results. Some people don’t see any results at all; because hypnosis thrives on suggestibility, if you’re not particularly suggestible it probably won’t work.

Choosing a Hypnotist
If you’re thinking about trying hypnotherapy, get a recommendation from your therapist. The American Society of Clinical Hypnosis also maintains a directory of qualified hypnotists with a clinical background. Make sure you know how long your hypnotist has been practicing and what methods he or she uses. The messages you hear under hypnosis should not come as a surprise, and your hypnotist should discuss the specific tools he or she is going to use before hypnotizing you.

Regression-based hypnosis, which is used to recover repressed memories, can be dangerous. Because people are more suggestible under hypnosis, the hypnotist can inadvertently fabricate memories that didn’t actually occur. Particularly if these memories are traumatic, this can lead to additional mental health issues. People with a history of psychosis should not undergo hypnosis without first taking to their doctors, because hypnosis increases their risk of a psychotic episode.

References:

1. About the society. (n.d.). American Society of Clinical Hypnosis. Retrieved from http://www.asch.net/
2. Beattie-Moss, M. (n.d.). Does hypnosis work? Research Penn State. Retrieved from http://www.rps.psu.edu/probing/hypnosis.html
3. Mental health and hypnosis. (n.d.). WebMD. Retrieved from http://www.webmd.com/anxiety-panic/guide/mental-health-hypnotherapy
4. Portenoy, R. (2008, August 18). How does hypnosis work, can anyone be hypnotized, and when is it used? ABC News. Retrieved from http://abcnews.go.com/Health/TreatingPain/story?id=4047906

It is not unusual for someone who experiences a loss to romanticize the person, identity, or object they are grieving. This can occur even when what is lost was not just imperfect, but harmful. This tendency occurs more often and can be more harmful with folks who experienced depression, anxiety, or other mental health issues prior to the loss.

Myths can be helpful in meeting the obligation of respect and mourning we may feel toward the person. They can push us to broaden our memory of the person who died or the relationship we had beyond just the negative event to more positive or helpful content. They can influence the “story” of what was lost in a way that makes thoughts and emotions associated with the loss more tolerable to access and communicate individually and within our support systems.

It is natural to go back in time and reevaluate our perceptions of events and the decisions made during that time. Those who struggle with depression or anxiety already have a distorted view of reality that usually presents a world that’s unsafe or themselves as incapable. Both of these factors can set the stage for harmful myths.

Beliefs that drive guilt, regret, and failure are usually present and, when applied to the loss of a relationship, can set the stage for a rewrite on reality. These factors can result in a person deriving a meaning or value from what was lost that is heightened and, in his or her mind, exposes an inability and unworthiness in obtaining and holding onto the things people deserve to pursue. Even if the person holds some, or the majority of, responsibility in the loss, what was lost was probably imperfect and the behaviors that led to the loss are changeable. We’re human, and life is usually a trial-and-error thing.

Myths can also amplify the lack of purpose one feels after losing a job, becoming hospitalized, or losing a relationship. This is particularly true if the loss involved something the person felt defined them: “This is who I was, and now that it’s gone, where does that leave me?” Myths can hold us to the belief that purpose is unchangeable and who we were before the loss was the best we could have been.

In reality, there may have been significant problems and costs to the identity that we were not attentive to; these costs may have been a factor in causing the loss. Myths hold us back from an honest analysis of what led us to “the problem,” which in turn, prevents us from changing our behaviors or priorities in a way that works for us now. Myths can make us risk-averse, because if it can’t be the same, what’s the point? The answer is that “it” being different may be what we need, and the loss could be used as a wake-up call. In holding onto myths, we may reenact patterns and behaviors that are maladaptive.

When the loss involves a person who was both a family member and a perpetrator, myths can act as an obstacle to accessing traumatic content. Survivors of childhood abuse utilize several strategies to survive their environments and maintain a positive view of those they love because of the meaning that relationship may have in their minds (“she is my mother; I’m supposed to love her”). From their perspective, pushing for change may have a greater cost than living with it. This capacity or inclination can prevent survivors from feeling as if they have permission to think about the person they lost in a negative light. These are common issues for any trauma survivor, but holding on to the myth after a loss may make the work in acknowledging and processing the trauma that much harder.

Within a familial context, myths can create a perceived demand for adherence to a “story” that may feel objectionable to some within the family. Trauma survivors can feel uncomfortable in processing the loss authentically with those they may feel closest to for fear of making waves or hurting them.

Grounding ourselves in fact can go a long way in helping us cope with a loss. Being factual means focusing on what we know, not what we believe, so that we can derive a reasonable meaning from the loss experience. It allows us to acknowledge and mourn the good while identifying what was harmful so that the work of adaptive grieving and behavior change can move forward.

One important aspect of remaining factual is communicating the emotional and cognitive content we hold to another person we trust. This allows us to expose any distorted beliefs or thinking to another person’s logic and perception. This is important because it creates an external brace against unreasonable thinking. By not allowing exposure, the only thing left to challenge the distorted narrative is the source of it.

Family, friends, and other natural supports (priests, rabbis, the lady who does your nails) are usually the best options if safety is not an issue because they represent long-term, sustainable resources you can access anytime. If safety is an issue or you are experiencing symptoms that go beyond a normal grief reaction, seeking professional help (therapists, psychiatrists, medical doctor) can provide more intensive support and a greater assurance of confidentiality.

People who have social anxiety (SAD) may find it difficult to interact with others. They may become overwhelmed with feelings of anxiety when they are in crowds or around people they do not know. But how does SAD affect interpersonal relationships, and in particular friendships? Thomas L. Rodebaugh of Washington University in Saint Louis, Missouri was curious to see how the constraints of anxiety spill over into personal relationships. Warmth, reciprocity, and genuine interest in another are at the core of all close friendships. If these elements are impaired they could significantly damage the relationship.

Rodebaugh led a study that involved 27 participants with generalized SAD and 23 with no history of anxiety. The participants were presented with a simulated social dilemma that required they make decisions and interact with a hypothetical friend. The results revealed that the SAD participants were less giving and less willing to participate in the task than the non-SAD participants. The lower level of giving resulted in increases in coldness as well. This result provides a clue as to why SAD may erode even close friendships.

If people are unable to convey warmth and return feelings of genuine interest to others, those around them, even close friends, may perceive that behavior as distant, callous, or uncaring. “Potential or current friends may interpret lower warmth as indicating coldness or lack of interest, both of which may reduce the likelihood that they will continue such interactions,” said Rodebaugh. This explains the pathway through which anxiety can erode friendships. Rodebaugh believes that people with SAD do not intend to alienate their friends but rather are unable to convey closeness because of their heightened anxiety. Most approaches aimed at reducing anxiety do not address interpersonal interactions. Rodebaugh believes that efforts designed to teach people with SAD how to display warmth and caring may serve to strengthen those relationships that are most important to them.

Reference:
Rodebaugh, T. L., Shumaker, E. A., Levinson, C. A., Fernandez, K. C., Langer, J. K., Lim, M. H., and Yarkoni, T. (2012). Interpersonal constraint conferred by generalized social anxiety disorder is evident on a behavioral economics task. Journal of Abnormal Psychology. Advance online publication. doi: 10.1037/a0030975

Don’t wait for trouble to set in when it comes to the enriching elements of your life, such as sensuality and sexuality. Often, we are draining ourselves of the essence in our sexual, erotic selves through seemingly small, inconsequential thought and behavioral patterns.

This article addresses some of the most common drains to our sexual energy. I encourage you to use it as an awareness-raising exercise and to begin to investigate your own energy drains. In response to what you learn from your own self-reflection and investigations, you may begin to compile and act on antidotes to your drains.

• The great storyteller: Being in your head too much creates performance anxiety and, sometimes, perfectionism. Telling yourself that your skills aren’t up to par, or wondering if your lover’s last lover was better or more interesting than you in the sex department, will keep you from fully engaging all your senses and fully being your erotic self. If you are telling yourself that sexual engagement with another (or yourself) has to look like candles and a quiet house, you are engaging in a false story and draining your sexual energy. You may have authored a story that is keeping you hostage.
• Swinging for the fences: When we engage in all-or-nothing thinking, we miss out on opportunities to replenish our sexual energy. No time for a long-lasting lovemaking encounter? Do not forgo a wonderful, engaged, 30-second kiss or a good, ol’-fashioned make-out session. The dog needs to be walked, there are bills to be paid, and you have phone calls to return, but give yourself time and space to indulge in some physical contact before tackling the rest of life. Trust me, it is far more enjoyable putting sexual energy replenishment at the top of your to-do list than skipping the kiss because you don’t have time for a full lovemaking session. When we assume sexual engagement must be a “home run” every time, we are draining ourselves and missing the opportunity to replenish our sexual energy.
• Relying on the goodness of others: Relying on your partner(s) to replenish your sexual energy by initiating or expressing interest is enemy No. 1. Your strength and sexual energy, including self-esteem, self-care, self-love, and empowerment, are all too often thought to be somebody else’s job. When we as individuals fulfill our own needs, we embark on a new way of relating to ourselves and others. To feel good about ourselves outside of the bedroom is essential to feeling good in the bedroom.
• Glory days: It’s particularly draining to ourselves, relationships, and sexual energy when we dwell on “better times” in our relationship. Within a longstanding relationship, we tend to think back to when we first met our partner and lament the times we couldn’t keep our hands off each other. One of the greatest gifts we have as humans is relating and relationships. Yes, it tends to be that the closer we get to our intimate partner, the flame can be dampened, however the fuel to that fire is drained only by focusing on “how it used to be.” In Patricia Love’s book, The Truth about Love: The Highs, the Lows, and How You Can Make It Last Forever, she shares with readers the predictable stages of “better times” and a more enriching, emotionally intimate relationship, which is often coupled with less “firework” sex. It is essential to understand the ebb and flow of sexual energy.
• Keeping score: Unresolved resentment and conflict, and not voicing our own needs, drains our sexual energy. Gatekeeping, policing, and “giving to get” drains the sexual energy from us and our relationships. Our sexuality is not a weapon or a reward system. When we engage in this thinking and pattern of interacting with our lovers, we drain the essence of our sexual selves.

So, what stories are you telling yourself? What habits need a little tweaking in order to replenish your sexual energy? I encourage you to monitor your own thinking and behavior patterns, and note what drains you and what replenishes you. Enjoy!

Perceptions of safety affect a person’s psychological state. If someone feels threatened or fearful, they may have increased levels of anxiety. If someone feels safe and protected, they may have high levels of self-confidence and feel more independent than someone that feels unsafe. The community in which a person lives can have a large impact on their mental well-being. People who live in high-crime, low-income neighborhoods are at increased risk for many negative outcomes, including drug abuse, relationship problems, violence, unwanted pregnancy, and depression. In fact, existing research has demonstrated a clear link between depression or anxiety and the environment in which a person resides. In particular, people living in communities in which they feel unsafe are more likely to have poor mental health outcomes than those in safer communities.

Until now, no study has looked at contributing factors that could increase or potentially protect individuals in unsafe neighborhoods from anxiety or depression. To accomplish this, Jaime Booth of the School of Social Work at Arizona State University led a study that examined isolation, powerlessness, and mistrust as predictors of feeling unsafe or safe in a sample of 4,196 participants. The results revealed that the more unsafe someone thought their neighborhood was, the worse they fared psychologically. Lack of safety was directly related to increased distress.

When Booth looked at the three secondary factors, the findings suggested that the distress from feeling unsafe could be enhanced or diminished. All three factors of powerlessness, mistrust, and isolation directly increased feelings of psychological stress. However, when participants reported high levels of trust, social support, or empowerment, they had lower levels of psychological stress. This suggests that increasing these domains in high risk individuals could lessen their feelings of helplessness, regardless of how safe their neighborhood is. “Understanding specific neighborhood factors that impact mental health enabled us to design more effective interventions and is crucial to addressing mental health disparities,” said Booth. The results of this study are one more in the continual pursuit of that goal.

Reference:
Booth, Jaime, Stephanie L. Ayers, and Flavio F. Marsiglia. Perceived neighborhood safety and psychological distress: Exploring protective factors. Journal of Sociology & Social Welfare 39.4 (2012): 137-56. Print.

Most people have experienced brief periods of anxiety while riding in an elevator, stuck in the midst of a large and tight crowd, or even while playing hide-and-seek. But for people with claustrophobia, the fear of being trapped in a small space can be so debilitating that it interferes with regular life activities.

In fact, the distinction between “normal” anxiety about enclosed spaces and phobic-level fear is the fact claustrophobia tends to interfere with life activities such as climbing a stairwell or riding in an elevator for work, playing with one’s children, or going to certain locations.

What Is It?
Claustrophobia is categorized by a chronic and unreasonable fear of being trapped in a small or enclosed space with no hope of escape, and it is classified as an anxiety disorder. People with claustrophobia also frequently experience a related fear of suffocation. Being in a small space can cause people with the issue to fear that they won’t be able to breathe, and for this reason, people with claustrophobia sometimes experience fear in settings that don’t seem enclosed or frightening. For example, a person with claustrophobia sitting in a dentist’s chair might be so afraid of confinement that the person becomes convinced that he or she will suffocate if he/she remains in the chair. People with the issue may experience extreme anxiety, panic attacks, difficulty breathing, profuse sweating, and difficulty concentrating when they are in a small space.

People with claustrophobia tend to experience anxious reactions in a variety of settings rather than just one particularly frightening setting. For this reason, claustrophobia tends to become generalized and may worsen over time. A person who was once afraid of elevators might generalize his or her fears to closets, apartments, doctor’s offices, and small stores. In extreme cases, people with claustrophobia may be so afraid of confinement that they refuse to leave their homes or travel to unfamiliar locations.

What Causes It?
Claustrophobia is one of the most common phobias, with about 5% of the population experiencing it to one degree or another. Some scientists believe that this indicates an evolved, genetic fear of closed spaces. The reasoning for this explanation is that being trapped in a small space can be dangerous, so the brain has evolved a special fear of these situations to prevent people from taking potentially life-threatening risks. However, there is also evidence that claustrophobia is learned. People who have been trapped in a small space—such as people who were trapped in an elevator or who were locked in their bedrooms as children—are more likely to become claustrophobic, and children of people with claustrophobia are more likely to become claustrophobic. This is probably due to a combination of genetics and parental modeling.

How Is It Treated?
Although phobias can be debilitating, they are generally fairly easy to treat. Counter-conditioning and exposure therapy work by gradually exposing people with claustrophobia to triggering circumstances to help them build a tolerance and learn coping mechanisms for their fears. People with mild claustrophobia sometimes benefit from deep-breathing techniques and distracting thoughts, and people with severe claustrophobia may take anti-anxiety medications to help them function until therapy can help them address the underlying causes of the phobia. Some people with claustrophobia also benefit from cognitive behavioral therapy, which helps them identify the negative thoughts that lead to fear-based reactions and to slowly adjust these thoughts to more positive, less fear-inducing ones.

References:

1. Claustrophobia. (n.d.). Epigee. Retrieved from http://www.epigee.org/mental_health/claustrophobia.html
2. Kahn, A. P., & Doctor, R. M. (2000). Facing fears: The sourcebook for phobias, fears, and anxieties. New York, NY: Checkmark Books.

Food Network chef Paula Deen is known for her bubbly personality, so many fans were shocked when she explained in her biography that she had agoraphobia for 20 years. Deen is hardly the only celebrity to experience this potentially debilitating condition, however. Kim Basinger and Woody Allen also reportedly have experienced it, and the father of modern psychiatry himself—Sigmund Freud—may have struggled with the issue as a young man.

In an increasingly busy, crowded, and connected world, anxiety can be overwhelming even for famous people, and agoraphobia will affect about 1.4 percent of the U.S. population at some point, with 40% of cases reported being “severe,” according to the National Institute of Mental Health.

What Is It?
Agoraphobia means “fear of the marketplace,” and is commonly associated with a shut-in lifestyle and social avoidance. However, agoraphobia is distinct from social phobia and characterized by a chronic fear of feeling anxiety or panic in a place where one is unable to escape or get help. For this reason, many people with agoraphobia are hesitant to leave their homes, unwilling to go out alone, or visit only familiar locations. Some people with the condition experience panic, generalized anxiety, and other issues classified as anxiety disorders.

Although everyone experiences anxiety in unfamiliar or social settings from time to time, people with agoraphobia experience overwhelming anxiety and panic on a regular basis. They might feel dizzy, restless, short of breath, or confused in unfamiliar settings. Agoraphobics are often fearful of feeling out of control, and the physical symptoms of anxiety can exacerbate this fear.

What Causes It?
Agoraphobia is typically a side effect of panic disorder. People who have had panic attacks in public settings may fear that they’ll have another panic attack and grow increasingly fearful of going out in public. Sometimes agoraphobia is caused by other circumstances, such as a traumatic event in a public place, social anxiety, or other mental health conditions that cause anxiety and panic. The disorder may be caused by a combination of genetic and environmental factors. Children of parents with panic disorder are more likely to develop agoraphobia; this could be due to either genetics or parental modeling.

How Is It Treated?
Because people with agoraphobia are often terrified of having panic attacks, one of the most important steps in treatment is giving the person a sense of control over his or her tendency to panic. Relaxation techniques can help many people regain a sense of control. Medication is also highly effective. Anti-anxiety medications and antidepressants can also help people with agoraphobia.

Sometimes agoraphobia causes so much fear that people refuse to leave their homes. People with severe agoraphobia sometimes need several months of progressive desensitization to fearful settings. For example, a person might start by walking outside, graduate to getting in the car, progress to driving to a parking lot, and ultimately master going to the grocery store. Most people with agoraphobia undergo some form of psychotherapy. Cognitive behavioral therapy can be especially helpful, and some people with the issue benefit from group therapy. Group members often share coping strategies and can help an agoraphobic feel less isolated; the group setting itself can also serve as a form of desensitization to unfamiliar people and settings.

References:

1. A.D.A.M. Editor Board. (2011, November 18). Panic disorder with agoraphobia. PubMed Health. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001921/
2. Agoraphobia among adults. (n.d.). NIMH RSS. Retrieved from http://www.nimh.nih.gov/statistics/1AGOR_ADULT.shtml
3. Agoraphobic celebrities. (n.d.). The Daily Beast. Retrieved from http://www.thedailybeast.com/galleries/2011/12/13/photos-paula-deen-kim-basinger-and-other-famous-people-with-agoraphobia.html
4. Mayo Clinic Staff. (2011, April 21). Agoraphobia. Mayo Clinic. Retrieved from http://www.mayoclinic.com/health/agoraphobia/DS00894
5. Moskin, J. (2007, February 28). From phobia to fame: A southern cook’s memoir. The New York Times. Retrieved from http://www.nytimes.com/2007/02/28/dining/28deen.html?pagewanted=all

The way in which a person reacts to stress can reveal a lot about their psychological state. Some theories exist that suggest that people with borderline personality (BPD) have an impaired reaction to stress, resulting in hyperactivity to stress and longer time to recover from stressful events. To test this theory, Lori N. Scott of the Department of Psychology at Pennsylvania State University led a study comparing stress reactivity in a group of female participants with BPD, traits similar to BPD (TM), and non-BPD traits (NTM). She measured the cortisol levels and the negative or positive affect of the women before and after they were exposed to stressors.

Scott found that the BPD women reacted less severely to stressors than the TM and NTM women. Although this finding was in contrast to some existing research, Scott believes there is a valid explanation for it. The BPD women had higher levels of stress, based on cortisol levels, and higher negative affect at baseline than the other women. Therefore, because their stress levels were elevated prior to being exposed to a stressor, their reaction to stress is less extreme than those with low baseline stress. Also, negative affect can dampen any reaction and weaken hyperactive stress responses.

When Scott looked at recovery time, she found that all the groups had similar rates of recovery from stress. Even though the BPD women experienced stress increases that were smaller in scale compared to the reactions of the other women, the time it took them to return to their elevated baseline stress levels was equal to that of the other women, whose stress increases were much steeper. “Our results provide some support for the high emotional intensity aspect, but not hyperreactivity and impaired recovery aspects, of current clinical theories of affective dysregulation in BPD,” said Scott. However, this study did not account for medication or comorbid conditions such as PTSD and substance use, all of which could influence stress reactivity in women with and without BPD. Future work may consider these issues when exploring the full range of reactions in women with BPD.

Reference:
Scott, L. N., Levy, K. N., and Granger, D. A. (2012). Biobehavioral reactivity to social evaluative stress in women with borderline personality disorder. Personality Disorders: Theory, Research, and Treatment. Advance online publication. doi: 10.1037/a0030117

The Diagnostic and Statistical Manual of Mental Disorders serves as the “bible” of mental health practitioners, who rely on it to match diagnostic criteria with behaviors. The American Psychiatric Association periodically examines trends in mental health conditions and recent scientific evidence to revamp the criteria. The latest edition, the DSM-5, is slated for release in May 2013, and the APA recently approved several changes.

Among the new diagnoses is excoriation, which is associated with chronic skin-picking. The issue is most common among women between the ages of 30 and 45. It’s classified as an impulse control disorder and is related to obsessive compulsion.

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What Is Excoriation?
Although excoriation disorder is the name of the new “official” diagnosis, the issue has been studied for years—sometimes called neurotic excoriation, compulsive skin-picking, dermatillomania, and psychogenic skin-picking. The issue was not included in previous editions of the DSM because it is believed to sometimes be a symptom of another issue.

Skin-picking is common among people with autism spectrum as well as obsessive compulsion. When it does not co-occur with another issue, however, it qualifies for its own diagnosis. Symptoms of the issue include compulsive skin-picking that leads to injuries or wounds as well as stress. Skin-picking is relatively common. Some people pick their skin to the point of bleeding or pain by popping pimples, picking at hangnails, or peeling scabs.

Controversy Surrounding Diagnosis
Whenever the APA adopts new diagnoses or symptoms, there is always some controversy, and excoriation is no exception. Although the diagnosis has received considerably less attention than some other changes, some mental health experts have expressed concern. Because excoriation often is a symptom of an underlying issue, a separate diagnosis might stigmatize people by giving them multiple diagnoses when only one is necessary.

Some clinicians have argued that excoriation does not meet the criteria for a mental health diagnosis and is more akin to a habit. By creating diagnostic criteria for a habit, the DSM might eventually have to include other habits. However, excoriation does sometimes occur on its own, and people with the condition can experience considerable distress, so the APA opted to include it.

How Excoriation Is Treated
When compulsive skin-picking occurs, it’s important to rule out a potential medical cause such as allergies or infection. Occasionally, skin conditions can superficially resemble symptoms of excoriation. Further, excoriation can cause dermatological problems, so patients frequently need dermatological treatment along with mental health treatment.

Antidepressants are the first line of treatment for excoriation. Opioid antagonist medications, which interfere with the body’s ability to respond to endorphins and opioids, also are sometimes effective. Because compulsive skin-picking often co-occurs with anxiety, anti-anxiety medications can be helpful.

Psychotherapy that helps people develop better approaches for dealing with anxiety, enables them to develop better impulse control, and helps patients cope with changes to appearance as a result of excoriation is also a typical part of treatment.

References:

1. American Psychological Association. APA concise dictionary of psychology. Washington, DC: American Psychological Association, 2009. Print.
2. Brauser, D. (2012, December 3). Experts react to DSM-5 Approval. Medscape Reference. Retrieved from http://www.medscape.com/viewarticle/775526
3. Colman, A. M. (2006). Oxford dictionary of psychology. New York, NY: Oxford University Press.
4. Neurotic excoriations. (2012, June 27). Medscape Reference. Retrieved from http://emedicine.medscape.com/article/1122042-overview
5. Neurotic excoriation. (n.d.). SkinPick. Retrieved from http://www.skinpick.com/neurotic-excoriation

Depression coupled with severe anxiety represents an often-debilitating psychiatric condition. Treatment is frequently a challenging proposition, marked by repeated trial and error. No two people are alike, and reactions to specific medications run the gamut from successful remission of symptoms to no effect whatsoever. In other cases, side effects may be so severe that someone is forced to discontinue a medication.

Severe mood issues and constant worry often lead to pronounced physical symptoms. Severe anxiety, for example, is well known to cause gastrointestinal complaints. Unfortunately, many of the most commonly prescribed antidepressant medications have stomach upset or nausea as one of their known side effects.

Sinequan (doxepin) is an older variety of antidepressant medication that has fallen out of favor because of its broad side effect profile. However, at low doses, these side effects mostly disappear. A pair of case studies demonstrated that a standard antidepressant such as Zoloft (sertraline), combined with low doses of Sinequan, offered noticeable improvements to both depression and anxiety without stomach upset. Both of these individuals had tried and failed with nearly every antidepressant and anti-anxiety medication on the market. Side effects or lack of noticeable benefit was the consistent result, regardless of treatment method.

Even combination treatments proved ineffective. Studies have shown that repeated non-remission of severe depression predicts a negative outcome. Therefore, discovering an effective treatment in these difficult cases is especially important.

Based on previous research findings, attending physicians in these case studies surmised that Sinequan would reduce or eliminate gastrointestinal symptoms at low doses. In the absence of nausea and stomach upset, the patients would be less inclined to discontinue their antidepressant regimen. Furthermore, the low dosage would avoid the most troubling of Sinequan’s side effects, such as drowsiness, weakness, and dry mouth. At regular doses, Sinequan has been known to cause nausea. The dosages in these case studies, however, were far below standard prescription levels.

For the people involved, remission of their gastrointestinal symptoms was instrumental in alleviating both their depression and anxiety. Further research will determine if low-dose Sinequan is applicable in a wider range of cases. The primary concern is with the safety of the medication, particularly in elderly patients or those with a long history of unsuccessful treatment.

References:

1. Doxepin – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved March 28, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000668/
2. MacLean, L., & Ahmedani, B. (2011). Sertraline and Low-Dose Doxepin Treatment in Severe Agitated-Anxious Depression With Significant Gastrointestinal Complaints:Two Case Reports. The primary care companion to CNS disorders, 13(4). Retrieved March 28, 2012, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219524/?tool=pmcentrez